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Abstract

Maternal and perinatal mortality is one of the biggest challenges to public health, especially
in developing countries. South Africa?s health care system is struggling to meet the “health
for all” criteria against a backdrop of staff shortages (especially midwives) in an HIV/AIDS
epidemic. These factors, together with the economic constraints of a developing country,
places great demands on delivering cost–effective, safe, quality intrapartum care that
exceeds expectations. The challenge for the manager is to organise the available resources
to render the best quality of care cost effectively within the shortest period of time. Various
reasons exist for the alarming shortage of nurses and midwives globally and also in South
Africa. Unhealthy practice environments are the main cause of the problem as such
environments have an impact on the job satisfaction of the midwives as well on patient
satisfaction. In the turmoil of the health care system, patients are demanding greater quality
of care and are insisting not only on excellent clinical skills, but also on empathetic and
personalised care.
This research was conducted to make a meaningful contribution to the body of knowledge,
specifically knowledge related to quality intrapartum care through the development of a
Quality Improvement Intervention Programme (QIIP?). The research was conducted in two
phases including five objectives. The first objective gave a theoretical foundation of quality
intrapartum care. The second objective included a situational analysis of the resources
(personnel and equipment) and determine the quality improvement initiatives that could be
implemented for intrapartum care. The third objective determined the practice environment
in maternity units at Level 2 hospitals in the North West province that may influence quality
intrapartum care. The fourth and last objective of Phase 1 determined the perceptions of
management and midwives regarding the facilitating and impeding factors that influence the
quality of intrapartum care. From the data that emerged from the first four objectives,
specific themes kept repeating themselves, namely structure (what must be in place, e.g.
infrastructure and human resources), process (what we do, e.g. life–long learning and
implementation of policies) and outcome (the results, e.g. patient satisfaction and a positive practice environment). These collectively contribute to the quality of intrapartum care
rendered.
Phase 2 consisted of the development of a “Quality Improvement Intervention Programme
(QIIP?)” for intrapartum care. In this phase the data from the first four objectives were used
to develop the QIIP?. The QIIP? will be marketed as an accreditation tool for maternity
units to measure themselves against the best in the world. Qualifying for QIIP? accreditation
means improving the quality of intrapartum care resulting in satisfied patients, the
establishment of a positive practice environment and a decrease in the Maternal Mortality
Rate (MMR).